DOCSLIB.ORG

Clinical, Tricoscopic and Histopathological Findings in Mexican Women with Traction Alopecia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical, Tricoscopic and Histopathological Findings in Mexican Women with Traction Alopecia Clinical Dermatology Open Access Journal MEDWIN PUBLISHERS ISSN: 2574-7800 Committed to Create Value for Researchers Clinical, Tricoscopic and Histopathological Findings in Mexican Women with Traction Alopecia Martínez Suarez H1*, Barrera Jacome A2, Ramirez Anaya M3, Barron Hernandez L4 and Morales Miranda AY5 Case Report Volume 5 Issue 3 1Dermatologist, Private practice in Marsu Dermatologia, Mexico Received Date: August 01, 2020 2Dermatopathologist, Deparment of Dermatology, Medical Specialties Unit, University of the Published Date: August 31, 2020 Army and Air Force, Mexico DOI: 10.23880/cdoaj-16000217 3Pediatric dermatologist, General Hospital in Cholula, Mexico 4Dermatologist and Dermatopathologist, Private practice in Puebla, Mexico 5Dermatologist, Deparment of Dermatology, Medical Medical Specialties Unit, University of the Army and Air Force, Mexico *Corresponding author: Martínez-Suarez Hugo, Dermatologist, Private practice in Marsu Dermatologia, 7 Sur 3118 Chula Vista, Puebla, Zip: 72420, Mexico, Tel: 522225052798; Email: [email protected] Abstract Traction alopecia is a common form of hair loss in our population. It is caused by vigorous straightening of the hair causing areas of alopecia. We studied 43 patients diagnosed with traction alopecia from a clinical, tricoscopic and histopathological guide. great tool in case of diagnostic doubt and provides relevant data related to the evolution time. We believe that the population This disease has a great diversity of clinical findings and can also vary depending on the time of evolution. Histopathology is of should change some hair styles to avoid progression to scarring alopecia. Keywords: Traction alopecia; Cicatricial alopecia; Marginal alopecia; Trichoscopy; Fringe sign Introduction and relaxers sustances. In Mexico and Latin America the use of ponytails is widespread. In India and Turkey the use of Traction alopecia is the hair loss caused by continuous, turbans predominates. All are worn for long periods of time vigorous and chronic tightening of the hair. It is a very a day for months or years [1-3]. common disease in African-American women [1]. However, in Latino and Asian populations, it is more frequent than This condition is not new, since there are descriptions previously thought. that identify it for more than 100 years. Trebitsch, a In each country and region, hair styling and hair to describe it. Similarly, in the last century, some writings alludingdermatologist to this of diseaseAustrian were origin, published, is apparently with datathe firstthat occupational, and religious issues. So, in the black currently continues to be valid. community,care styles arebraids, dictated weaves and and influenced dreadlocks by aresociocultural, used with more frequency, in addition to the use of chemical smoothing The pathophysiology, it has not been fully identified. Clinical, Tricoscopic and Histopathological Findings in Mexican Women with Traction Alopecia Clin Dermatol J 2 Clinical Dermatology Open Access Journal The main cause known is the constant and strong pulling projections (frontal and bilateral) and trichoscopic of the or traction of the hair. The hair is damaged when the hair involved areas. We used descriptive statistics. prolonged periods [2]. Results fiber is tightened or stretched throughout its extension, for These different hairstyle styles give rise to diverse Forty-three women, aged 16 to 56 years (mean 33.9 ±) clinical forms. That depend on the evolution time and can be were included. Educational level was: (30%) high school, different in initial and late stages, even in the same patient (30%) bachelor, (27%) middle high school, (9%) primary, [3]. (2%) studies at master’s level. Regarding the occupation we found: (45%) housewives, (16%) nurses, (15%) teachers or The most commun clinical characteristics are: decreased educators, (7%) others (employees, merchants, secretaries), capillary density in the marginal zone of the hair, alopecic (13%) students (Table 1). plaques with the presence of hairs, peri and interfollicular erythema, as well as the described “fringe sign” [4]. The range in the evolution time was from 1 to 35 years, with a mean of 16 years. 16 (37%) of them manifested less than 10 years of evolution and 27 (63%) more than 10 years However, the diagnosis can be a true challenge. Especially, with the problem. if theTheoretically, patient does traction not alopeciaprovide isthe not informationdifficult to identify. about the hairstyle she uses or event deny to use it. It is often Regarding the clinical characteristics, we observed: confused with other hair disorders such as alopecia areata decrease in density or alopecic plaques in 100%, vellous hair characteristics. It is important to mention that this kind of erythema, six cases with peripheral papules and pustules in alopeciaor frontal does fibrosing not provide alopecia much due bothsymptomatology, can share some especially clinical twoin forty-two (5%) patients cases (Table(97%), 2) thirty-five (Figure 1). (79%) with peripheral in its initial stages. Trichoscopy is an important tool for the diagnosis of hair diseases. And in this condition it becomes essential, because a differentThe tricoscopic level in twenty-two findings were: (51%), peripyllari perifollicular cast in brownthirty- allowed to identify if is an initial or advanced stage. And pigmentfive (79%), in blackthirty-three dots in (77%),twenty-eight empty (53%), follicular broken openings hairs inat allows to identify if it is a scarring or non-scarring alopecia [5]. white dots in eight (19%), pilli torti in three (7%) and trichorhexistwenty-six (60%). nodosa As in extratwo patiens findings, (5%) we (Table observed 3) (Figure irregular 2). Although it is a frequent cause of alopecia, there are few studies about their clinical and trichoscopic characteristics. As mentioned, we carried out a histopathological study Most of the publications are isolated case reports. in some cases with the intention of observing the changes reported in the literature which are dependent on chronicity Material and Methods and thus establish the differences. In the patients with less than ten years we observed: preserved sebaceous glands in Retrospective, descriptive and cross-sectional review. six (75%), a decrease in terminal hairs in all of them (100%), We reviewed the clinical records of patients with traction alopecia diagnosed for two dermatologist in Mexico City and Puebla, México. Along one year (January 2019 to January fibrotic fibrous tracts in three (37%), and sparse lymphocytic 2020). The diagnoses was established with the clinical and inflammationIn chronic in formsseven (87%)we observed (Table 4) decrease (Figure 3).in follicular density in the 88%, as well as an increase in the number of perfomed a biopsy per 4 mm cylinder, carrying out two cuts: follicles in catagen / telogen. Two patients (25%) presented onetrichoscopic longitudinal findings. and transverse, If the diagnosis in both caseswas doubtful,staining with we a decrease in the terminal / hairy ratio. Trichomalacia, hematoxylin and eosin. The variables analyzed were: age, pigment casts, or peripheral / intrafollicular hemorrhage occupation, educational level, time of use of hairstyle (years), were not observed in any of the biopsies studied. Alteration also clinical characteristics as erythema, follicular papules, of follicular architecture was observed in two patients follicular pustules, peripillary cylinders, vellous hairs (25%). 100% of the patients presented preserved sebaceous erythema, peripheral brown pigmentation, peripillary casts, tracts (Figure 4). Two patients (25%) presented peripheral blackand alopecic dots, broken patches). hairs Trichoscopic of different findings:lengths andperipheral empty glands, a peripheral inflammatory infiltrate and fibrous follicular openings. Clinical photographs were taken in 3 (12.5%) (Figure 5). fibrosis. Only one patient presented “naked” hair follicles Martínez Suarez H, et al. Clinical, Tricoscopic and Histopathological Findings in Mexican Copyright© Martínez Suarez H, et al. Women with Traction Alopecia. Clin Dermatol J 2020, 5(3): 000217. 3 Clinical Dermatology Open Access Journal Figure 1: Women of 44 years old with traction alopecia. Figure 4: tracts. Peripheral inflammatory infiltrate and fibrous tracts. peripheral inflammatory infiltrate and fibrous Figure 2: Girl of 16 years old, with alopecic patches located in bitemporal regions, we can see erythema and perifolcular papules. In the tricoscopy we can observe vellous hair, Black dots, peripheral marron pigmentation and hemorragic crust. Findings suggestive of traction folliculitis. Figure 5: Naked hair follicles. Level of Number Percentage Occupation Percentage studies Bachelor 13 30% Housewives 45% High school 13 30% Nurses 16% Middle high 11 27% Teachers 15% school Primary 4 9% Students 13% Master level 1 2% Other 7% Table 1: 43 women, aged 16 to 56 years (mean 33.9 ±) and occupation. Figure 3: Preserved sebaceous glands and peripheral inflammatory infiltrate. Martínez Suarez H, et al. Clinical, Tricoscopic and Histopathological Findings in Mexican Copyright© Martínez Suarez H, et al. Women with Traction Alopecia. Clin Dermatol J 2020, 5(3): 000217. 4 Clinical Dermatology Open Access Journal Number of Percentage buns and turbans, the most common presentation is a Clinical Characteristics Patientes (%) “marginal pattern”, located in the bitemporal region of the scalp (frontal, temporoparietal and even occipital hairlines) Decrease in density 43 100%
Load more

Recommended publications
  • Fungal Infections from Human and Animal Contact
    Journal of Patient-Centered Research and Reviews Volume 4 Issue 2 Article 4 4-25-2017 Fungal Infections From Human and Animal Contact Dennis J. Baumgardner Follow this and additional works at: https://aurora.org/jpcrr Part of the Bacterial Infections and Mycoses Commons, Infectious Disease Commons, and the Skin and Connective Tissue Diseases Commons Recommended Citation Baumgardner DJ. Fungal infections from human and animal contact. J Patient Cent Res Rev. 2017;4:78-89. doi: 10.17294/2330-0698.1418 Published quarterly by Midwest-based health system Advocate Aurora Health and indexed in PubMed Central, the Journal of Patient-Centered Research and Reviews (JPCRR) is an open access, peer-reviewed medical journal focused on disseminating scholarly works devoted to improving patient-centered care practices, health outcomes, and the patient experience. REVIEW Fungal Infections From Human and Animal Contact Dennis J. Baumgardner, MD Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI; Center for Urban Population Health, Milwaukee, WI Abstract Fungal infections in humans resulting from human or animal contact are relatively uncommon, but they include a significant proportion of dermatophyte infections. Some of the most commonly encountered diseases of the integument are dermatomycoses. Human or animal contact may be the source of all types of tinea infections, occasional candidal infections, and some other types of superficial or deep fungal infections. This narrative review focuses on the epidemiology, clinical features, diagnosis and treatment of anthropophilic dermatophyte infections primarily found in North America.
    [Show full text]
  • INFORMATION PAPER Department of the Army, G-1 15 Nov 19 SUBJECT
    INFORMATION PAPER Department of the Army, G-1 15 Nov 19 SUBJECT: DACOWITS December 2019 RFI 9: Effect of Grooming Standards on Women’s Health 1. Purpose: To reply to the DACOWITS Effect of Grooming Standards on Women’s Health for December 2019 Quarterly Business Meeting. Military grooming standards ensure Service members are able to meet their occupational demands and maintain a professional appearance. However, sometimes these standards can unmask or exacerbate various skin conditions. According to the American Academy of Dermatology, traction alopecia is hair loss that is caused by repeat pulling on the hair due to tight hairstyles. Servicewomen can develop this condition if they wear their hair in a tight ponytail, bun, or braids, especially in combination with the use of chemicals or heat. Servicewomen have expressed to DACOWITS that specific grooming standards are causing them non-reversible hair loss. The Committee is concerned about the potential unintended consequences and impact of grooming standards on women’s long term health. Question 9a: Provide policies, regulations, and other directive sources that describe grooming standards for servicewomen. Include specifics that may be required for certain military specialties or working conditions, as well as any variances or allowances for racial or ethnic groups Response 9a: Army Regulation (AR) 670-1 Wear and Appearance of Army Uniforms and Insignia, paragraph 3-2 a. (3) “The requirements for hair regulations are to maintain uniformity within a military population for female Soldiers while in uniform, or in civilian clothes on duty, unless otherwise specified. Female hairstyles may not be eccentric or faddish and will present a conservative, professional appearance.
    [Show full text]
  • Traction Alopecia: a Clinical Approach to Diagnosis and Management Edidiong Celestine Ntuen Kaminska, MD; Shani Francis, MD, MBA; Sarah L
    Case RepoRt Traction Alopecia: A Clinical Approach to Diagnosis and Management Edidiong Celestine Ntuen Kaminska, MD; Shani Francis, MD, MBA; Sarah L. Stein, MD Traction alopecia (TA) is a form of hair loss that is caused by excessive tension on scalp hair. Hair loss from TA can occur in any area of the scalp where there has been sustained pull on hairs. Various hairstyles and hairstyling techniques frequently have been associated with TA, and patients of any age or race can be affected. We report 2 cases of TA in black females and review the clinical characteristics of TA as well as the challenges that patients and physicians face in managing and treating this condition. COS DERMCosmet Dermatol. 2012;25:118-124. ultural, social, and cosmetic practices influ- tension leads to mechanical detachment of the hair shaft ence how hair is styled. Grooming practices from the follicle, ultimately resulting in follicular atrophy that traumatize the hair or scalp may result and permanent alopecia.4 in both temporary and permanent damage Traction alopecia can be classified as marginal or non- or hair loss, which also may cause psy- marginal based on the distribution of hair loss. Marginal Cchologic distress. Acquired hair injury due to exogenous hair loss occurs along the frontal, temporal, and parietal exposure may contribute to aesthetically displeasing hair hairlines and has been associated with continued use of Do Not1 Copy texture, color, luster, elasticity, and manageability. Traction chemical relaxers and rollers or wearing hair in ponytails, alopecia (TA) is a type of acquired hair loss that results tight cornrows, dreadlocks, and weaves.2,5-7 Nonmarginal from excessive tension on scalp hair.
    [Show full text]
  • The “Fringe Sign” a Useful Clinical Finding in Traction Alopecia of the Marginal Hair Line Aman Samrao1, Daniel Zedek2, Vera H
    erimenta xp l D E e r & m l a a t c o i l n o i Journal of Clinical & Experimental Samrao et al. J Clin Exp Dermatol Res 2011, 2:2 l g y C f R DOI: 10.4172/2155-9554.1000117 o e l ISSN: 2155-9554 s a e n a r r u c o h J Dermatology Research Research Article Open Access The “Fringe Sign” A Useful Clinical Finding in Traction Alopecia of the Marginal Hair Line Aman Samrao1, Daniel Zedek2, Vera H. Price1,3 and Paradi Mirmirani1,3,4* 1Department of Dermatology, University of California, San Francisco, CA, USA 2Department of Dermatopathology, University of California, San Francisco, CA, USA 3Department of Dermatology, Kaiser-Permanente Medical Group, Vallejo, CA, USA 4Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA Abstract Background: Traction alopecia is hair loss due to prolonged or repetitive tension on the hair. Diagnostic challenges may be encountered if the clinical suspicion for traction is not high, or if the history of traction is remote or not obtained. Since pathologic features can vary dramatically with the stage of the disorder clinico-pathologic correlation is essential. We have made the observation that the presence of retained hairs along the frontal and/or temporal rim, which we termed the “fringe sign”, is a finding that can be see in both early and late traction alopecia, and thus may be a useful clinical marker of the condition. Objective: To determine the frequency of the fringe sign in a series of patients with a diagnosis of traction alopecia.
    [Show full text]
  • Mastering Clinical Conditions on the Dermatology Recertification
    Index A central centrifugal cicatricial alopecia , 303 Acanthosis nigricans , 160, 185 discoid lupus erythematosus , 304 Accessory (supernumerary) digit , 321 dissecting cellulitis , 304–305 Accessory tragus , 319 folliculitis decalvans , 305 Achrocordon , 353 frontal fi brosing alopecia , 306 Acne keloidalis nuchae , 306 lichen planopilaris , 303 Acne rosacea traction alopecia , 307 erythematotelangiectatic , 93–94 Amiodarone , 434 granulomatous , 96 Amyloidosis ocular , 95 lichen , 141 papulopustular , 94–95 macular , 141 phymatous , 95 primary nodular cutaneous , 142 rosacea fulminans , 97 primary systemic , 142–143 Acne vulgaris , 91 Anagen effl uvium , 300 Acquired digital fi brokeratoma , 323 Androgenetic alopecia Acquired hypertrichosis lanuginosa , 189 female pattern , 300 Acquired perforating dermatosis , 183, 519 male pattern , 301 Acral lentiginous melanoma , 387–388 Angioedema , 453 Acrodermatitis enteropathica , 152 Angiosarcoma , 369–370 Actinic cheilitis , 367 Anogenital warts , 221 Actinic keratosis , 365–366 Aphthous stomatitis , 316 Actinic purpura , 426 Aplasia cutis congenita , 215–216 Acute cutaneous lupus erythematosus , 108–109 Apocrine miliaria. See Fox–Fordyce disease Acute febrile neutrophilic dermatosis. See Sweet’s syndrome Arteriovenous malformation (AVM) , 471 Acute generalized exanthematous pustulosis (AGEP) , 433 Asteatotic dermatitis , 18 Acute graft-versus-host disease , 129 Atopic dermatitis Acute hemorrhagic edema of infancy , 44–45 adult , 16–17 Acute herpes zoster ophthalmicus , 231 childhood , 15–16 Acute radiation dermatitis , 429 infantile , 15 Addison’s disease , 169 Atrophie blanche. See Livedoid vasculopathy Adnexal tumors AVM. See Arteriovenous malformation (AVM) cylindroma , 326–327 multiple trichoepitheliomas , 326 nevus sebaceous , 328–329 B poroma , 330 Bacterial folliculitis syringoma , 327 pseudomonas folliculitis , 257 trichoepithelioma , 325 staphylococcal folliculitis , 255–256 trichofolliculoma , 329 Bacterial infections African endemic Kaposi’s sarcoma , 380 bullous impetigo , 261 AGEP.
    [Show full text]
  • Buffalo Medical Group, P.C. Robert E
    Buffalo Medical Group, P.C. Robert E. Kalb, M.D. Phone: (716) 630-1102 Fax: (716) 633-6507 Department of Dermatology 325 Essjay Road Williamsville, New York 14221 2 FOOT- 1 HAND SYNDROME 2 foot - 1 hand syndrome is a superficial infection of the skin caused by the common athlete's foot fungus. It is quite common for people to have a minor amount of an athlete's foot condition. This would appear as slight scaling and/or itching between the toes. In addition, patients may have thickened toenails as part of the athlete's foot condition. Again the problem on the feet is very common and often patients are not even aware of it. In some patients, however, the athlete's foot fungus can spread to another area of the body. For some strange and unknown reason, it seems to affect only one hand. That is why the condition is called 2 foot - 1 hand syndrome. It is not clear why the problem develops in only one hand or why the right or left is involved in some patients. Fortunately there is very effective treatment to control this minor skin problem. If the problem with the superficial fungus infection is confined to the skin, then a short course of treatment with an oral antibiotic is all that is required. This antibiotic is very safe and normally clears the skin up fairly rapidly. It is often used with a topical cream to speed the healing process. If, however, the fingernails of the affected hand are also involved then a more prolonged course of the antibiotic will be necessary.
    [Show full text]
  • Dermoscopic Approach to a Small Round to Oval Hairless Patch on the Scalp
    WH Shim, et al Ann Dermatol Vol. 26, No. 2, 2014 http://dx.doi.org/10.5021/ad.2014.26.2.214 ORIGINAL ARTICLE Dermoscopic Approach to a Small Round to Oval Hairless Patch on the Scalp Woo-Haing Shim1, Seung-Wook Jwa1, Margie Song1, Hoon-Soo Kim1, Hyun-Chang Ko1,2, Byung-Soo Kim1,2, Moon-Bum Kim1,2 1Department of Dermatology, 2Medical Research Institute, Pusan National University School of Medicine, Busan, Korea Background: Various kinds of alopecia can show small oval hairless patch showed characteristic findings for each round or oval hairless patch. Dermoscopy could be a simple, disease. Based on these results, we propose dermoscopic useful tool for making a correct diagnosis. Objective: The algorithm for small round or oval hairless patch on the scalp. aim of this study is to investigate clinical usefulness of (Ann Dermatol 26(2) 214∼220, 2014) dermoscopy for diseases with small round or oval hairless patch on the scalp. Methods: Dermoscopic examination was -Keywords- performed for 148 patients with small round or oval hairless Alopecia, Dermoscopy patch using DermLiteⓇ II pro. The type and its patient number of alopecia investigated in the study were as below: alopecia areata (n=81), trichotillomania (n=24), tinea cap- INTRODUCTION tis (n=13), traction alopecia (n=12), lichen planopilaris (n= 8), discoid lupus erythematosus (n=7), congenital triangular The presence of a small round or oval hairless patch on alopecia (n=2) and pseudopelade of Brocq (n=1). The the scalp can be observed in many diseases, such as significance of dermoscopic findings for each disease were alopecia areata (AA), trichotillomania (TM), tinea capitis evaluated.
    [Show full text]
  • ABSTRACT INTRODUCTION Clinical Synopsis
    1 Volume 22 Number 9 2 September 2016 3 4 Letter 5 Bitemporal hair loss related to traction alopecia 6 Oscar Muñoz Moreno-Arrones, Sergio Vañó-Galván 7 Dermatology Online Journal 22 (9): 16 8 Dermatology Department, Hospital Ramon y Cajal, Madrid, Spain 9 Correspondence: 10 Oscar Muñoz Moreno-Arrones 11 Email: [email protected] 12 13 14 15 16 17 18 ABSTRACT 19 We present a 24-year-old woman that had received a diagnosis of alopecia areata in the past and was treated with topical 20 corticosteroids with little improvement. Instead, the patient exhibited bitemporal alopecia of one year of evolution related to 21 traction alopecia. Traction alopecia is characterized by localized hair loss related to persistent excessive traction. Although it is 22 initially a reversible condition, if this excessive traction is not removed permanent alopecia may develop. 23 Keywords: Traction alopecia ; trichology; alopecia; hair; hair loss; trichoscopy; focal hypotrichosis; 24 peripilar casts 25 INTRODUCTION 26 Traction alopecia is a form of hair loss that may leave permanent alopecia if not resolved at its earlier stages. It is produced by 27 a maintained tension of the hair. Its prevalence is directly linked to the existence of traction hairstyles and is much more 28 frequent in African American women. Cessation of the traction-causing hairstyle is mandatory for the resolution of this 29 alopecia. 30 Clinical synopsis 31 A 24-year-old woman presented to our department with a bifronto-temporal patchy alopecia. The patient noted that the lesions 32 appeared at about the time she received a diagnosis of ulcerative colitis the year before.
    [Show full text]
  • Hair Disorders in Women of Color☆,☆☆
    International Journal of Women's Dermatology 1 (2015) 59–75 Contents lists available at ScienceDirect International Journal of Women's Dermatology Updates in the understanding and treatments of skin & hair disorders in women of color☆,☆☆ Christina N. Lawson, MD a,b,⁎, Jasmine Hollinger, MD a, Sumit Sethi, MD c, Ife Rodney, MD a, Rashmi Sarkar, MD c, Ncoza Dlova, MBChB, FCDerm (SA) d, Valerie D. Callender, MD a,b a Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia b Callender Dermatology & Cosmetic Center, Glenn Dale, Maryland c Department of Dermatology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India d Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa article info abstract Article history: Skin of color comprises a diverse and expanding population of individuals. In particular, women of color repre- Received 22 December 2014 sent an increasing subset of patients who frequently seek dermatologic care. Acne, melasma, and alopecia are Received in revised form 15 April 2015 among the most common skin disorders seen in this patient population. Understanding the differences in the Accepted 15 April 2015 basic science of skin and hair is imperative in addressing their unique needs. Despite the paucity of conclusive data on racial and ethnic differences in skin of color, certain biologic differences do exist, which affect the disease presentations of several cutaneous disorders in pigmented skin. While the overall pathogenesis and treatments for acne in women of color are similar to Caucasian men and women, individuals with darker skin types present more frequently with dyschromias from acne, which can be difficult to manage.
    [Show full text]
  • Hair Disorders – a Case Based Approach
    Hair Disorders – A Case Based Approach Daniel Stulberg, MD Professor of Family and Community Medicine University of New Mexico Some slides courtesy E.J. Mayeaux, Jr., MD 1 Disclosure Statement: • Co-Author, • Dermatologic and Cosmetic Procedures in Office Practice. Elsevier, Inc., Philadelphia. 2012. • Cutaneous Cryosurgery. Fourth Edition. CRC press 2014. 2 Objectives •Recognize normal hair anatomy and physiologic changes in hair •Evaluate the chief complaint of hair loss •Utilize effective medical interventions for hair disorders, when appropriate 3 Life Cycle of a Hair • Anagen phase (active growth) - 2-7 years • Catagen (transitional/follicular regression) - 2-3 weeks • Telogen (preshedding or rest) about 3 Months • Hair released and shed at end of telogen • > 85% of hairs of the scalp are in anagen • Longer anagen phase = Longer hair 4 Life Cycle of a Hair •We have all terminal hair follicles at birth •Hair grows at 0.35 mm/day = 1 cm /month •Each hair follicle’s cycle is usually asynchronous with others around it •We lose ~75-100 hairs a day • Same number of hairs enter anagen phase • Telogen hairs are characterized by a mature root sheath, or "club," at the proximal end Price VH. Treatment of hair loss. N Engl J Med 1999; 341:964. 5 Hair Classification •Terminal (large) hairs • Found on the head and beard • Larger diameters and roots that extend into sub q fat Daniel Stulberg, MD 6 Hair Classification • Vellus hairs are smaller in length and diameter and have less pigment • Intermediate hairs have mixed characteristics Daniel Stulberg, MD 7 Alopecia Definition • Partial or complete loss of hair from where it would normally grow Celestino FS, Alopecia.
    [Show full text]
  • Update on Alopecia and CCCA
    Update on African American Hair and Scalp Disorders Heather Woolery-Lloyd, M.D. Director of Ethnic Skin Care Voluntary Assistant Professor Miller/University of Miami School of Medicine Department of Dermatology and Cutaneous Surgery Central Centrifugal Scarring Alopecia ▪ Progressive scarring alopecia on the vertex of the scalp but does not assume a particular cause ▪ “Cicatricial” and “Scarring” frequently used interchangeably ▪ Prevalence 2.7% (S. Africa)- 5.7% (NAHRS) ▪ Although inflammation was absent in the original description, current consensus is that inflammatory papules may be present in early disease Ogunleye, Temitayo A., Amy McMichael, and Elise A. Olsen. "Central centrifugal cicatricial alopecia: what has been achieved, current clues for future research. " Dermatologic clinics 32.2 (2014): 173-181. Central Centrifugal Cicatricial Alopecia-What’s New? CCCA –Autosomal Dominant Fourteen index African families in South Africa 31 immediate family members participated in the initial screening The female to male ratio was 29:2 Average age of 50.4 years Average age of onset 41 years All patients displayed histologic features typical for CCCA Pedigree analysis suggested an autosomal dominant mode of inheritance Dlova, Ncoza C., et al. "Autosomal dominant inheritance of central centrifugal cicatricial alopecia in black South Africans." Journal of the American Academy of Dermatology 70.4 (2014): 679-682. CCCA –Hair Grooming Habits Hair grooming markedly influenced disease expression CHLG greater than 2 48% practiced frequent braiding and weaving for hair grooming 29% gave a history of braiding or weaving on chemically processed hair relaxed or permed CHLG 0 to 1 35% had natural virgin hair, had never used any chemicals or traction on their hair, and maintained short hairstyles These were either very young (<15 years) or very old (>75 years) female participants who had escaped the latest hair-grooming trends, or males who had kept natural short haircuts Dlova, Ncoza C., et al.
    [Show full text]
  • Cicatricial Alopecia
    1 CICATRICIAL ALOPECIA Dr R Newaj Specialist Dermatologist MBBCh (Wits) FC Derm Introduction In layman’s terms alopecia = baldness. Though it is not a life-threatening disease, it can have a huge psychological impact on both males and females. For centuries scalp hair has been used to differentiate females from males (though not so much these days). Various cultures are defined by their hair styles; the Rastas, Hare Krishnas, the Sikhs and Punks. Though a bald scalp is used as a trade mark for Skinheads, majority of patients are very distressed by alopecia. Alopecia can be divided into non-scarring and scarring. The non-scarring types are more common and if detected early, are usually reversible. Scarring (cicatricial) alopecia is more often permanent and little can be done to reverse it. In cicatricial alopecia there is permanent destruction of the pilosebaceous units and they are replaced by fibrous tissue. There is loss of the hair ostia on the skin surface and with time the scalp may appear smooth and shiny. Cicatricial alopecia is divided into either primary cicatricial alopecia (PCA) or secondary cicatricial alopecia (SCA). In primary cicatricial alopecia, the hair follicle is the target of inflammatory destruction, with little effect on other dermal components. In secondary cicatricial alopecia, the hair follicle is an “innocent bystander” and is destroyed indirectly. Primary cicatricial alopecia Table1: Common causes of Primary cicatricial alopecia Lymphocytic Lichen planopilaris Frontal fibrosing alopecia Graham- Little syndrome Pseudopelade of Brocq Central centrifugal cicatricial alopecia Discoid lupus erythematosus Alopecia mucinosa Keratosis folliculitis spinulosa decalvans Neutrophilic Folliculitis decalvans Tufted folliculitis Dissecting cellulitis/folliculitis Mixed Acne keloidalis nuchae Erosive pustular dermatosis Non-specific (end stage) 2 1.
    [Show full text]